These sessions include: orientation to CBT-AD, activity scheduling, adaptive thinking (two sessions), problem solving (two sessions), relaxation, and relapse prevention. As empirically tested, CBT-AD is approximately 12 sessions long, with three “open sessions” built into treatment, which allows for the patient and therapist to revisit the modules that are most relevant to the patient’s specific needs. In clinical practice, flexibility in the length and selection of each module is encouraged, due to the complex concerns that arise with individuals who have medical and

psychological comorbidity. Life-Steps (Safren et al., 1999) was originally developed as a single-session intervention that utilizes cognitive-behavioral, problem-solving (D’Zurilla, 1986), and motivational interviewing (Miller & Rollnick, 1991) techniques to improve motivation, enhance adherence-related behaviors, Protease Inhibitor Library manufacturer and address barriers and solve problems that interfere 3-deazaneplanocin A in vivo with

adherence to HIV medications. In CBT-AD, we start with this intervention as a way to begin to address adherence, and then all future sessions monitor and build upon strategies discussed during this session. Accordingly, the treatment of depression is integrated into the treatment of problematic adherence. This session begins by conducting a motivational exercise in which patients list their thoughts about taking their medications (both positive and negative), their own personal barriers to optimal adherence, and their primary reasons for staying healthy. This exercise elicits critical information that will be used throughout treatment to anticipate barriers to adherence and enhance motivation to change unhealthy behaviors. The session proceeds with a psychoeducational component (Life-Step 1) that provides information about Phosphatidylinositol diacylglycerol-lyase the importance of medication adherence and the risks associated with nonadherence (e.g., disease progression, treatment resistance). In the final component of the Life-Steps session, patient and therapist review the 10 remaining life-steps that affect medication

adherence, and address barriers to each life-step using the “AIM” problem-solving approach to address barriers (ARTICULATE the particular adherence goal, IDENTIFY barriers to reaching the goal, and MAKE a plan to overcome the barriers, including a backup plan). In addition to psychoeducation (Life-Step 1), the life-steps reviewed in this session include: (2) getting to appointments; (3) communicating with treatment team; (4) coping with side effects; (5) obtaining medications and other relevant health-related products; (6) formulating a daily medication schedule; (7) storing medications and medical supplies; (8) cue-control strategies for taking medications; (9) handling slips in adherence; (10) life-steps review; and (11) life-steps follow-up (occurs during a follow-up phone call or Session 2 of CBT-AD).